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    <p class="text-success" class="text-center"><strong>(057)777-0-666 (099)311-0-666 (093)789-0-666</strong></p>

    
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     <div class="span3">
    </br> 1 EUR = 10.86 грн
    </br>1 USD = 8.1 грн
    </br>1 RUS = 0.28 грн
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<body>
   <img class="img-font" title="AutoCartel" alt="AutoCartel" src="../img/reg.png" data-id="8022"></img>    
 </br>
<form action="#############" name="commentform" id="commentform">
<p><input type="text" name="family-client" id="family-client" value="" size="25" />
<small>Фамилия*</small>
</p>
<p><input type="text" name="name-client" id="name-client" value="" size="25" />
<small>Имя*</small>
</p>
<p><input type="text" name="1-name-client" id="1-name-client" value="" size="25" />
<small>Отчество</small>
</p>
</br>
<p><input type="text" name="firm" id="firm" value="" size="25" />
<small>Название фирмы/компании</small>
</br>

</br>

                                <select id="select_auto_used_state" name="state">
                                    <option value="0">Выберите</option>
                                    
                                        <option value="1">Винница</option>
                                    
                                        <option value="11">Днепропетровск</option>
                                    
                                        <option value="13">Донецк</option>
                                    
                                        <option value="2">Житомир</option>
                                    
                                        <option value="14">Запорожье</option>
                                    
                                        <option value="15">Ивано-Франковск</option>
                                    
                                        <option value="10">Киев</option>
                                    
                                        <option value="16">Кировоград</option>
                                    
                                        <option value="17">Луганск</option>
                                    
                                        <option value="18">Луцк</option>
                                    
                                        <option value="5">Львов</option>
                                    
                                        <option value="19">Николаев</option>
                                    
                                        <option value="12">Одесса</option>
                                    
                                        <option value="20">Полтава</option>
                                    
                                        <option value="9">Ровно</option>
                                    
                                        <option value="21">Симферополь</option>
                                    
                                        <option value="8">Сумы</option>
                                    
                                        <option value="3">Тернополь</option>
                                    
                                        <option value="22">Ужгород</option>
                                    
                                        <option value="7">Харьков</option>
                                    
                                        <option value="23">Херсон</option>
                                    
                                        <option value="4">Хмельницкий</option>
                                    
                                        <option value="24">Черкассы</option>
                                    
                                        <option value="6">Чернигов</option>
                                    
                                        <option value="25">Черновцы</option>
                                    
                                </select>
                                <small>Регион*</small>
                            
</br>
<p><input type="text" name="city" id="city" value="" size="25" />
<small>Город*</small>
</p>


</form>
</body>
   </div>
   <div class="span5">
    <p class="text-success"> Уважаемые клиенты! Просим Вас внимательно заполнять информацию о себе, во избежание проблем при получении груза на транспортных компаниях Украины.</p>
        
 <div class="alert alert-danger">
  Поля с примечанием * являются обязательными к заполнению
</div>
</br>
<p><input type="text" name="email" id="email" value="" size="25" />
<small>E-mail*</small>
</p>
</br>
</br>
<p><input type="text" name="city" id="city" value="" size="25" />
<small>Пароль*</small>
</p>
<p><input type="text" name="city" id="city" value="" size="25" />
<small>Подтвердите пароль*</small>
</p>
</br>
</br>
</br>

<input type="checkbox"></input>  Я хочу стать постоянным клиентом компании <b>AutoCartel</b> и учавствовать в <a href="#">программе лояльности</a>
</br>
</br>
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        <p> Компания <a href="../index.html" target="_blank">AutoCartel</a></p>
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